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Evidence-informed health policy 2 - Survey of organizations that support the use of research evidence.
No full textABSTRACT: BACKGROUND: Previous surveys of organizations that support the development of evidence-informed health policies have focused on organizations that produce clinical practice guidelines (CPGs) or undertake health technology assessments (HTAs). Only rarely have surveys focused at least in part on units that directly support the use of research evidence in developing health policy on an international, national, and state or provincial level (i.e., government support units, or GSUs) that are in some way successful or innovative or that support the use of research evidence in low- and middle-income countries (LMICs). METHODS: We drew on many people and organizations around the world, including our project reference group, to generate a list of organizations to survey. We modified a questionnaire that had been developed originally by the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE) collaboration and adapted one version of the questionnaire for organizations producing CPGs and HTAs, and another for GSUs. We sent the questionnaire by email to 176 organizations and followed up periodically with non-responders by email and telephone. RESULTS: We received completed questionnaires from 152 (86%) organizations. More than one-half of the organizations (and particularly HTA agencies) reported that examples from other countries were helpful in establishing their organization. A higher proportion of GSUs than CPG- or HTA-producing organizations involved target users in the selection of topics or the services undertaken. Most organizations have few (five or fewer) full-time equivalent (FTE) staff. More than four-fifths of organizations reported providing panels with or using systematic reviews. GSUs tended to use a wide variety of explicit valuation processes for the research evidence, but none with the frequency that organizations producing CPGs, HTAs, or both prioritized evidence by its quality. Between one-half and two-thirds of organizations do not collect data systematically about uptake, and roughly the same proportions do not systematically evaluate their usefulness or impact in other ways. CONCLUSION: The findings from our survey, the most broadly based of its kind, both extend or clarify the applicability of the messages arising from previous surveys and related documentary analyses, such as how the 'principles of evidence-based medicine dominate current guideline programs' and the importance of collaborating with other organizations. The survey also provides a description of the history, structure, processes, outputs, and perceived strengths and weaknesses of existing organizations from which those establishing or leading similar organizations can draw
HPV RNA-test for livmorhalskreft
No full text3-PAGE EXECUTIVE SUMMARY\ud
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Background\ud
Cervical cancer is the second most common cancer in women world-wide and affects about 300 women in Norway each year. Cervical cancer develops through cellular abnormalities in the cervix that can be detected by cytological tests. With the intro-duction of organized cervical cytologic screening programs, the incidence of cervical cancer has been dramatically reduced. However, cytologic screening tests also have limitations, especially their limited sensitivity.\ud
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Because infection with oncogenic human papillomavirus (HPV) has been identified as the underlying cause of cervical cancer, there is interest in the use of HPV testing as a screening test for cervical cancer. The overall prevalence of HPV among cervical cancers is more than 99 %.\ud
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We have evaluated HPV RNA testing for cervical pre cancer lesions by assessing the diagnostic accuracy of the HPV RNA tests compared with cytology and HPV DNA testing.\ud
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Methods\ud
We have systematically searched the following databases for studies that fulfilled our criteria:\ud
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* Medline (Ovid) 1966 – 2007, September week 1\ud
* Embase (Ovid) 1980 – 2007 week 37\ud
* CRD databases (DARE, NHS EED, HTA) 2007, September\ud
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Relevant topics and text words were combined. We also composed a search filter for diagnostic studies.\ud
NorChip AS who has developed a HPV mRNA test was invited to dispatch documen-tation.\ud
We included published literature based on the following criteria:\ud
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Population: Women\ud
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Index test: HPV RNA tests\ud
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Comparators: HPV DNA tests or cytology for screening of cervical cancer\ud
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Reference standard: Histology\ud
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Study design: No limit\ud
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Outcome:\ud
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Test sensitivity and specificity, positive and negative predic-tive value or other values that describe diagnostic accuracy\ud
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Development of cancer\ud
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Test reliability\ud
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Language: English and Scandinavian\ud
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We did not include publications from conferences or abstracts.\ud
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Relevance and quality was assessed according to our handbook (1). We used GRADE to assess the documentation for diagnostic accuracy. The results are presented in tables and in a descriptive summary. This work has been carried out by two re-searchers at NOKC and the report has been externally reviewed.\ud
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We calculated diagnostic accuracy using 2 x 2 tables for each study, table A.\ud
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Results\ud
We identified 2498 references and assessed 31 full-text articles. Five studies were included in the report and results were extracted and pooled from three of them. De-tails of each study are presented in evidence tables, appendix 6. Two of the studies were sponsored by the producers of the tests.\ud
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The results for diagnostic accuracy are shown in table B. We have assessed the qual-ity of the documentation of diagnostic accuracy using GRADE, table B. For HPV RNA testing, the quality is very low which means that the results are very uncertain. It is not known whether HPV RNA testing give a better diagnostic accuracy than HPV DNA testing and cytology.\ud
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In summary these results showed:\ud
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The HPV RNA tests had slightly lower sensitivity compared with HPV DNA tests (77 % (95 % CI 73-81) versus 92 % (95 % CI 89-94), while cytology had lowest sensitiv-ity (61 %). The sensitivity states the probability of a positive test result if you have the disease.\ud
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The HPV RNA tests had slightly higher specificity compared with HPV DNA tests (64 % (95 % CI 60-68) versus 45 % (95 % CI 41-49)), while cytology had highest specificity (81 %). The specificity states the probability of a negative test result if you are healthy.\ud
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The HPV RNA tests had comparable positive predictive value with the HPV DNA tests (63 % (95 % CI 59-67) versus 57 % (95 % CI 53-60), while cytology had the highest positive predictive value (91 %). Positive predictive value states the prob-ability of illness among people with a positive test.\ud
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The HPV RNA tests had slightly lower negative predictive value compared with the HPV DNA tests (78 % (95 % CI 74-82) versus 87 % (95 % CI 83-91)), while cytology had the lowest negative predictive value (39 %). Negative predictive value states the probability of illness among people with a negative test.\ud
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Conclusions\ud
Due to spare and low quality documentation, we do not know if HPV RNA tests have a better diagnostic accuracy compared to HPV DNA tests and cytology for detection of cervical pre cancer lesions.\ud
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Norwegian Knowledge Centre for the Health Services summarizes and disseminates evidence concerning the effect of treatments, methods, and interventions in health services, in addition to monitoring health service quality. Our goal is to support good decision making in order to provide patients in Norway with the best possible care. The Centre is organized under The Directorate for Health and Social Affairs, but is scientifically and professionally independent. The Centre has no authority to develop health policy or responsibility to implement policies
Kostnader og leveårsgevinster ved medikamentell primærforebygging av hjertekarsykdom
No full textBACKGROUND\ud
Cardiovascular disease (CVD) has for decades been the most common cause of death in Norway and most other Western countries. Several groups of drugs have shown in clinical trials to prevent CVD. In this report, we have evaluated the cost-effectiveness of these drugs.\ud
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METHODS\ud
Based on a model of the progression of CVD from healthy to death, we explored which drugs that might be cost-effective. Analyses were conducted both compared to no treatment and between different drugs. Analyses were conducted on different risk levels and in different age groups for both men and women. We also performed probabilistic sensitivity analyses. Our analyses were accompanied by a systematic review of other economic evaluations of preventive strategies against CVD.\ud
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RESULTS\ud
Calcium channel blockers, thiazides, beta blockers, aspirin and statins were all cost-effective compared to no treatment for all groups of men and women in age groups between 40 and 69. The life year gains for each of the drugs varied between 3 and 17 months. Calcium channel blockers and thiazides were the most cost-effective combination of two antihypertensive drugs. In the base case analyses, the combination of calcium channel blockers, thiazides and ACE-inhibitors was the most cost-effective combination of three drugs. The sensitivity analyses indicate considerable uncertainty related to the question of which was the most cost-effective of the antihypertensive drugs. Whether treatment was cost-effective compared to no treatment was concerned with less uncertainty. Our systematic review of other economic evaluations showed considerable discrepancies between analyses of prevention strategies against CVD.\ud
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DISCUSSION\ud
The results of this study indicate that statins, several antihypertensives and aspirin are cost-effective in all analysed groups between 40 and 69 years old. It is worthwhile noting, however, that the model is built on numerous assumptions, and this introduces considerable uncertainty with respect to optimal choice of therapies
Indoor tanning in Norway. Regulations and inspections
No full textRapporten presenterer regelverk for kosmetiske solarier i Norge, hvordan dette er overholdt og\ud
UV stråling fra tilgjengelige solarier i Norge. Tilsyn avslørte mange brudd på regelverket og alt\ud
for høy kortbølget UV stråling i solariene. Langbølget UV stråling i både de godkjente og de\ud
inspiserte solariene var omtrent tre ganger høyere enn for sommersol i Sør-Norge.The report presents Norwegian regulations regarding indoor tanning, compliance with these and\ud
UV irradiance from the sunbeds. Inspections revealed low compliance and too high short wave\ud
UV irradiance. The long wave UV irradiance was more than three times higher than for summer\ud
sun in South Norway in approved as well as in inspected sunbeds
The Obsessive-Compulsive Symptom (OCS) scale of the Child Behavior Checklist: a comparison between Swedish children with Obsessive-Compulsive Disorder from a specialized unit, regular outpatients and a school sample.
No full textTo evaluate the discriminative power of various items as reported by parents in the OCS-scale extracted from the Child Behavior Checklist (CBCL) problem scale and to compare findings with outcomes of previous validation studies. Children referred to a specialized child psychiatric Obsessive-Compulsive Disorder (OCD) clinic (OCD group) (n=185) receiving a formal OCD diagnosis according to DSM IV criteria based on interviews with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were compared to a sample recruited from regular child and adolescent psychiatric outpatient clinics (CPO group) (n=177). Both samples were compared to a normative school sample (SS group) and all three groups were matched for age and gender. Thirty seven CBCL items, mostly representing core internalizing symptoms and parts of the thought problem scale as well as physical and sleep problems, were first identified. Ten of these items (including all discriminative items in previous validation studies) could distinguish children with OCD from CPO patients. In a subsequent analysis, the results of a logistic regression showed that four CBCL items, "Obsessions," "Fearful and Anxious," "Compulsions," and "Worries" remained significant predictors. These four OCS items and previously used CBCL OCS-scales were further examined by means of ROC-analysis showing that the "Obsessions" and "Compulsions" CBCL items were the strongest predictors. These two CBCL items performed well as screens for OCS symptoms in children and adolescents and the addition of similar CBCL items did not further increase sensitivity or specificity. It is suggested that parental responses on these two items could preferably be used as screen for OCD in children and adolescents in regular child psychiatric clinics
Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study.
No full textBACKGROUND: Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute (< 14 days disease duration) and subacute osteomyelitis (> or = 14 days disease duration), and differentiate osteomyelitis patients from those with other acute onset musculoskeletal features. METHODS: In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. RESULTS: The total annual incidence rate of osteomyelitis was 13 per 100,000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100,000). The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3-3.7). The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002). Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3-14.7). ESR > or = 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43%) patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. CONCLUSION: The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis
Avlastning og støttekontakt – tjenester med betydning for et bedre liv! Oppsummering av landsomfattende tilsyn i 2007 med avlastnings- og støttekontakttjenester etter sosialtjenesteloven
No full textNORSK SAMMENDRAG:\ud
Fylkesmennene gjennomførte i 2007 landsomfattende tilsyn med avlastnings- og støttekontakttjenester etter sosialtjenesteloven. Fylkesmennene undersøkte om kommunene sikrer:\ud
forsvarlig tildeling av støttekontakt- og avlastningstjenester etter sosialtjenesteloven § 4-2, bokstav b (avlastningstiltak for personer og familier som har et særlig tyngende omsorgsarbeid) og c (støttekontakt for personer og familier som har behov for dette på grunn av funksjonshemming, alder eller sosiale problemer) \ud
at avlastere og støttekontakter har nødvendig kunnskap og tilstrekkelige ferdigheter\ud
Tildeling av tjenester omfattet både informasjon om tjenestene, saksbehandlingsprosessen med utredning og vurdering, samt iverksetting av vedtak om avlastning og støttekontakt.\ud
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I 61 av de 66 undersøkte kommunene konstaterte fylkesmennene svikt på ett eller begge områdene de undersøkte. I to tredjedeler av kommunene fant fylkesmennene svikt når det gjelder tildeling av avlastning- og støttekontakttjenester. Godt over halvparten av kommunene sørget ikke for at avlastere og støttekontakter hadde tilstrekkelig kunnskap og ferdigheter til å utføre arbeidet. Mange av kommunene som ble undersøkt hadde utfordringer knyttet til å sikre systematisk styring, ledelse og forbedringsarbeid i avlastnings- og støttekontakttjenestene. \ud
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Fylkesmennene følger opp tilsynet overfor de enkelte kommunene.SUMMARY IN ENGLISH:\ud
In 2007 the County Governors carried out countrywide supervision of respite care and support contact services, as laid down in the Social Services Act. The aim of supervision was to investigate whether the municipalities ensure that:\ud
support contact services and respite care are allocated in accordance with the requirements laid down in the Social Services Act, section 4-2, b (measures to provide respite for persons and families with especially burdensome caring work) and c (support contacts for persons and families in need of them owing to disability, age or social problems) \ud
people who provide respite care and support have adequate knowledge and skills.\ud
Supervision of allocation of services included the areas of providing information about the services, administrative procedures related to assessment of clients, and implementation of decisions about respite care and support contact services.\ud
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In 61 of the 66 municipalities where supervision was carried out, the county governors detected deficiencies in one or both of the areas investigated. In three-quarters of the municipalities, the county governors detected deficiencies related to allocation of respite care and support contact services. Over half of the municipalities did not ensure that people who provided respite care or support had adequate knowledge and skills to carry out their work. In many of the municipalities there was potential for improvement in the management and leadership of the services, and improvement of respite care and support contact services. \ud
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The county governors will follow up the municipalities where supervision was carried out
Chocolate bar as an incentive did not increase response rate among physiotherapists: a randomised controlled trial.
No full textABSTRACT: BACKGROUND: The aim of this study was to assess the effect of a small incentive, a bar of dark chocolate, on response rate in a study of physiotherapy performance in patients with knee osteoarthritis. FINDINGS: Norwegian physiotherapists from private practice were randomised in blocks to an intervention group (n = 1027) receiving a bar of dark chocolate together with a data-collection form, and a control group (n = 1027) that received the data-collection form only. The physiotherapists were asked to prospectively complete the data-collection form by reporting treatments provided to one patient with knee osteoarthritis through 12 treatment sessions. The outcome measure was response rate of completed forms.Out of the 510 physiotherapists that responded, 280 had completed the data-collection form by the end of the study period. There was no difference between the chocolate and no-chocolate group in response rate of those who sent in completed forms. In the chocolate group, 142 (13.8%) returned completed forms compared to 138 (13.4%) in the control group, ARR = 0.4 (95% CI: -3.44 to 2.6). CONCLUSION: A bar of dark chocolate did not increase response rate in a prospective study of physiotherapy performance. Stronger incentives than chocolate seem to be necessary to increase the response rate among professionals who are asked to report about their practice. TRIAL REGISTRATION: Current Controlled Trials register: ISRCTN02397855
Strålevernet si overvaking av radioaktivitet i luft - resultatrapport for luftfilterstasjonar 2005-2006
No full textRapporten inneheld resultat frå luftovervakinga til Strålevernet i\ud
perioda 2005 - 2006.The report summarizes the data from NRPA’s high volume\ud
airfilter stations in the period 2000 - 2004